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The condition can lead to complications affecting not just the spine, but the eyes and heart.

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At least half a million Americans have ankylosing spondylitis (AS), a painful and sometimes debilitating arthritis of the spine. Most people with the condition experience lower back pain and stiffness, but AS can be unpredictable and lead to a range of other complications affecting different parts of the body.

According to the Spondylitis Association of America, there are more cases of AS than there are of cystic fibrosis, multiple sclerosis, and Lou Gehrig’s Disease combined. AS is an inflammatory disease that attacks the joints, especially the sacroiliac joints where the spine and the pelvis join. The inflammation can develop in other areas as well, such as the hips, neck, shoulders, and knees.

Many people with AS will never develop complications, but it’s important to know that the condition can mean much more than an aching back. By spotting AS-related symptoms as early as possible, patients can avoid potentially serious health consequences.

Spine and Back Concerns

Research has linked even early-stage AS to low bone mineral density, osteoporosis, and an increased risk for fractures of the bones in the spinal column, or vertebrae.

“The main and most common complication is developing a rigid spine, which can make moving around very difficult,” said Scott Zashin, MD, a rheumatologist in Dallas and a member of the American College of Rheumatology. “AS patients, particularly those with a rigid back, are also susceptible to fractures. Any minor trauma can cause a life-threatening fracture especially when the spine is involved, so people who have even a minor fall need to be seen by a doctor.”

As the condition progresses and the body tries to protect itself, new bone can form between the spine’s vertebrae causing them to fuse together. That fusion can cause a curvature of the spine known as kyphosis.

“As AS goes on longer, it can cause spinal deformity where the patient is bent over at the lower back or neck,” said Alpesh Patel, MD, chief of orthopedic spine surgery and co-director of the Northwestern Spine Center. “To correct that, we can do a surgical procedure called an osteotomy, where we break the spine and realign it. It’s one of most complicated surgeries we do and requires a lot of time for recovery.”

Eye Problems

Four out of 10 people with AS experience eye inflammation known as uveitis. “The most common type of uveitis in the front part of the eye, is called anterior uveitis, or iritis,” according to Brian Proctor, DO, a Loyola University Medicine ophthalmologist at Gottlieb Memorial Hospital in Chicago. The condition, which can affect one or both eyes, causes blurred vision, redness, and sensitivity to light.

Uveitis can be treated with eye drops, steroids, and dark glasses to protect the eyes. Symptoms sometimes subside without treatment, but they can also worsen and lead to other complications. An eye exam can help spot AS in someone who didn’t know they had the disease. “If an eye doctor diagnoses uveitis in a young adult who also has back pain and stiffness, that is a big red flag for ankylosing spondylitis," said Dr. Proctor.

Cardiovascular Risk

Studies have shown that AS increases the risk for heart disease and stroke by as much as 60 percent, especially among younger adults. “Most rheumatic diseases are associated with increased risk for cardiovascular disease,” according to David Pisetsky, MD, chief of rheumatology at Duke University Medical Center in Durham, N.C. ”When the immune system gets inflamed, it may play out in the cardiovascular system as much as the joints.”

The reason is likely a combination of the inflammation associated with the disease, the side effects of anti-inflammatory drugs, and the fact that AS patients are frequently less active due to the pain. Experts agree that managing heart disease risk factors – watching your diet and, if possible, exercising— is key, along with regular visits to a rheumatologist and a cardiologist.

Other Inflammatory Issues

Many people with ankylosing spondylitis experience intense fatigue because the pain makes it difficult to sleep and their body is using a lot of energy to handle the inflammation.

As Rochelle Rosian, MD, director of regional rheumatology at the Cleveland Clinic, points out, “the fatigue of inflammation is not just in your head — it’s due to a cascade of inflammatory reactions that affect your whole body.” Regular exercise, good sleep habits, and a diet high in proteins and healthy fats can help ease the fatigue.

“Inflammatory arthritis conditions can also cause stomach problems like Crohn’s and colitis,” said Patel. “The inflammation can go haywire and affect multiple places in the body.”

Patel stresses the importance of having “a really good primary care doctor who knows what things can come up with AS [and] getting specialists involved if you’re concerned about any complications.”

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